CELLCEPT CAPSULES 250MG (500 CT) (500 BOT) (NDC: 00004025943)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible |
Does Plan Offer Gap Coverage |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Blue Medicare HMO Standard (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$80.00 | $200.00 | P | $1,062.33 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,061.68 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
Patriot Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,068.03 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
SecurityChoice Plus (PFFS)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $212.50 | P | $1,140.43 |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Southeast Community Care - Dual Plus (HMO)
|
$0.00 |
$310 |
to be determined |
2 |
Tier 2 |
n/a | n/a | P | n/a |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | P | $1,068.48 |
Browse Plan Formulary |
Southeast Community Care - Plus (HMO)
|
$0.00 |
$0 |
to be determined |
3 |
Tier 3 |
$39.00 | $78.00 | P | $1,068.48 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-134 (PFFS)
|
$18.90 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-136 (PFFS)
|
$20.70 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$21.00 |
$0 |
to be determined |
3 |
Tier 3 |
$69.00 | $138.00 | P | $1,068.03 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.24 |
Browse Plan Formulary |
Evercare Plan MH (HMO)
|
$21.30 |
$0 |
to be determined |
3 |
Tier 3 |
$85.00 | $245.00 | P | $1,060.24 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,088.87 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Four (P
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,095.32 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,083.49 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
CIGNA Medicare Access Plus RX Plan Two (PF
|
$22.50 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,075.16 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
Humana Gold Choice H2944-133 (PFFS)
|
$25.50 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,059.01 |
Browse Plan Formulary |
HumanaChoice R5826-079 (Regional PPO)
|
$25.60 |
$310 |
to be determined |
2 |
Tier 2 |
25% | 25% | P | $1,060.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-135 (PFFS)
|
$26.60 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,055.46 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Humana Gold Choice H2944-137 (PFFS)
|
$31.80 |
$0 |
to be determined |
2 |
Tier 2 |
$40.00 | $100.00 | P | $1,056.54 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.48 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.48 |
Browse Plan Formulary |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.48 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Southeast Community Care - Enhanced (HMO)
|
$34.90 |
$310 |
to be determined |
3 |
Tier 3 |
25% | 25% | P | $1,068.48 |
Browse Plan Formulary |
HumanaChoice R5826-003 (Regional PPO)
|
$39.20 |
$0 |
to be determined |
2 |
Tier 2 |
$42.00 | $105.00 | P | $1,060.48 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible |
Gap Coverage |
Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Presidential Plus (PFFS)
|
$43.30 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $150.00 | P | $1,066.54 |
Browse Plan Formulary |
Blue Medicare HMO Enhanced (HMO)
|
$59.20 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,062.33 |
Browse Plan Formulary |
Blue Medicare PPO Enhanced (PPO)
|
$85.80 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,062.33 |
Browse Plan Formulary |
Blue Medicare PPO Enhanced Freedom (PPO)
|
$90.80 |
$0 |
to be determined |
3 |
Tier 3 |
$75.00 | $187.50 | P | $1,062.33 |
Browse Plan Formulary |